ABSTRACT. With funding support from NICHD R01HD087993, we have been enrolling consenting pregnant and breastfeeding women living with HIV and their HIV-exposed infants in a study entitled ?Long term outcomes of therapy in women initiated on lifelong ART because of pregnancy in DR Congo.? The parent study aims to identify modifiable health delivery system factors associated with retention in care and sustained virological suppression, and to evaluate the effectiveness of continuous quality improvement (CQI) interventions to improve long-term retention in care and virological suppression. A key secondary outcome of the parent study is survival of HIV-exposed un-infected (HEU) infant participants. CQI interventions are expected to improve attendance to clinic visits and adherence to antiviral therapy (ART). While adherence to ART during pregnancy could increase the risk of poor pregnancy outcomes, adherence to clinic visits is expected to increase the use of other preventive services such as intermittent preventive treatment for malaria, which is highly prevalent in the Democratic Republic of Congo (DRC) and is a major contributor preterm birth and low birthweight. Thus, to fully assess the effect CQI on HIV-free survival, we need to account for the effects of CQI on maternal and placental malaria burden. This administrative supplement will enable us to collect biological samples, including placental biopsies and peripheral blood, from 600 pregnant women living with HIV (PWLHIV). Malaria parasitemia will be assessed in these samples, which will enable us to determine how maternal and placenta malaria modifies the effect of CQI on HIV-free survival in HEU infant participants. Understanding how CQI interventions impact long-term survival among participating women and their infants will facilitate its adoption both locally in DRC and regionally in sub-Saharan Africa.